Category Archives: MEDICAL MOMENTS from Steve

MEDICAL MOMENTS WITH STEVE: WHO KNOWS? SURPRISE ENDING

Some may question the advisability of airing this confessional remembrance to a broad audience, but Steve says that, for him, it is a story of efficiency gone horribly wrong, an inadequate reaction, and a singular event that can haunt one for a lifetime.  

SURPRISE ENDING

by Steve Goldfinger

He was in his mid-forties, comatose, febrile, and near the end. His hemophilia had caused uncontrollable bleeding throughout his body, and bacteria had infected his blood-laden tissues. A young attending, I led my team of house staff and students on rounds in our critical care area, stopping at his bedside only briefly. We had come to recognize that a huge number of transfusions had not made a difference; we could not stop the bleeding; and no new antibiotic was going to reverse the course. His vital signs told us he had entered the final stage. There was no family to contact, no friends we knew of. I commented that death was near and that no new measures made any sense. As we moved on to the next patient, our senior resident left us and went back towards the nurse’s station. We didn’t know why; nor did we ask. There were too many patients to be seen.

About 15 minutes later, he returned. “Well, it’s over,” he announced. When I asked what he meant, he told us. He had loaded a syringe with a lethal dose of potassium chloride and injected it into the dying patient’s vein. Instantaneous death occurred when it reached the heart and stopped it from beating.

Silence.

I was staggered by what he had done, so staggered that I was unable to say a word. We looked at each other. The group looked at me. I could not talk, could not imagine how he could have done such a thing, could not find a way to convert busy patient rounds into an ethics seminar. Could not even reprimand him as much as I felt I needed to.

Why? I continue to ask myself 40 years later.  Was I so intent on getting to all the patients that I failed to take a mandatory time out?  Was I unwilling to chastise him in front of all the others?  Would doing so require an explication of the moral principles he had violated? And was I capable of summoning up those principles and expressing them in an articulate way without time to recall them, reflect on them? Or, perhaps, did a small part of me completely understand what he had done and found it within reasonable, if not ethical, boundaries?

We received his report, and, a moment later, moved on to the next bedside without comment. Nor did I bring up this abhorrent act for discussion the following morning.

To this day, I am ashamed. I wonder how those students and interns regarded my silence.  Did they think this was a routine rite of passing endorsed by me, my colleagues, our profession? I can only hope that, as they moved on in their training, they came to recognize the event as the horrendous anomaly it was.

But in thinking about it now, was that injection of potassium chloride very different from the morphine drip that would some day come to use…ostensibly to reduce suffering…but, so often, in amounts that terminate breathing prematurely?

Who knows?

BOLLI Matters feature writer Steve Goldfinger

After a long career in medicine, Steve has been exploring his artistic side.  At BOLLI, he has taken writing courses, been active in the Writers Guild, and even tried CAST (Creativity in Acting, Storytelling, and Theatre) where his imagination made him a singular player!

 

MEDICAL MOMENTS WITH STEVE: WHO KNOWS? TWO CANCERS

TWO CANCERS

by Steve Goldfinger

The patient had turned 50 and was in perfect health when she went for her first colonoscopy. There, at the very last segment of bowel to be examined, was a small cancer growing in the region of her appendix. Surgery to remove it was performed the next week. Seventeen months later, she was dead from metastases throughout her body.

At age 55, my father noted constipation. Within weeks, he was unable to have a bowel movement. As a physician who was well aware of his own body, he could recognize each wave of peristalsis curving in his abdomen and then stopping abruptly where his colon met his rectum. He told me these things the night he brought home the films from the barium enema he’d gone through that day. Without doubt, a cancer completely obstructed his bowel. The next day, he signed in to the local community hospital, spared the foreign intern by cavalierly writing his own history into the chart, and called upon his surgical buddy “Chippy” to do the operation. No need for a major medical center or a renowned surgeon to take care of things. And Chippy was pretty good at what he did.

My mother and I sat in the waiting room, she in her thoughts and I in mine.  A third year medical student having just completed a three month exposure to surgery, I expected the worst. When Chippy finally came in, I saw him smile. “No lymph nodes,” he exclaimed, “it all grew in.”  My father lived another 32 years with nary a bowel complaint.

“It all grew in.”

Just what signal from the interior of my father’s bowel had directed those cancer cells inward?  And with such force as to not allow any to escape in the other direction. Was it anything akin to the earth’s magnetic field that directs each salmon to its personal spawning rivulet? Impossible. Swallows travel 6,000 miles to return to Capistrano to resettle in their cliff nests each year. Instinct, memory, wind currents, and who knows what else. Nothing that seems to pertain to a cancer cell.

More likely, my father’s cancer cells didn’t all home inward. Perhaps some escaped from his colon but could not thrive in the outer world. Possibly, they found the soil of whatever tissue they reached inhospitable, not letting them set up shop and multiply. Or perhaps his cancer cells, unlike those of my patient,  were unable to secrete a fertilizing substance that would allow them to dig deep and flourish in foreign lands.

Questions begging for answers.

Who knows?

BOLLI Matters feature writer Steve Goldfinger

After a long career in medicine, Steve has been exploring his artistic side.  At BOLLI, he has taken writing courses, been active in the Writers Guild, and even tried CAST (Creativity in Acting, Storytelling, and Theatre) where his imagination made him a singular player!